GPs over-prescribing antibiotics should face GMC, says NICE

GPs needlessly handing out antibiotics should be disciplined to help curb the growing number of unnecessary prescriptions, Mark Baker, director of the Centre for Clinical Practice at the National Institute for Health and Care Excellence, has reportedly said.

His comments come with a renewed attempt by the Institute to secure more effective antimicrobial stewardship across the country, with new guidelines for healthcare professionals and commissioners designed to cut antibiotic prescribing by 25%.

If doctors fail to stick to its guidance they should be reported to the General Medical Council he said, also suggesting that prescriptions should detail diagnoses to enable pharmacists to challenge the prescription if necessary, reports The Telegraph.

“We need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of colleagues when these are not in line with local and national guidelines and no reason is documented,” he said in a release from the Institute.

Overall the use of antibiotics in England has been steadily increasing over several years, with 41.6 million prescriptions issued nationally in 2013/14 at a cost to the NHS of £192 million. But, despite repeated guidance and calls to cut prescribing rates, 90% of GPs still feel pressured to prescribe them, and 97% of patients who ask for antibiotics are given them.

“Resistance to antibiotics is increasing and there have been very few new antibiotics developed in recent years, so we need to make sure that, as well as searching for new antimicrobial medicines we use the ones we currently have in the most effective way,” said Tessa Lewis, GP and Medical Advisor to All Wales Therapeutics and Toxicology Centre and Vice Chair of the Guideline Development Group.

“The rise in inappropriate prescribing comes in the face of successive attempts by NICE and by government to reduce it that simply haven't worked.”

10 million prescriptions unnecessary

The Institute says if its latest guidance is properly implemented it could slash yearly antibiotic prescriptions by 10 million.

In the first instance, its wide-reaching guidelines call for commissioners to ensure that antimicrobial stewardship operates across all care settings as part of an antimicrobial stewardship programme, and that multidisciplinary teams should be set up to review prescribing and resistance data.

Its raft of recommendations also advise doctors not to prescribe antibiotics to a patient who is likely to have a self_limiting condition, and to consider point_of_care testing in primary care for patients with suspected lower respiratory tract infections.

Tim Ballard, Vice Chair of the Royal College of GPs, welcomed “the team approach” to ensure appropriate antibiotic prescribing and the opportunity for reflection “as long as it is implemented in an open and supportive way”. But he also argued that “any suggestion that hard pressed GPs - who are already trying to do their jobs in increasingly difficult circumstances - will be reported to the regulator is counter productive and unhelpful”.